[Oropharyngeal dysphagia and aspiration]

Adherence to commercial food thickener in patients with oropharyngeal dysphagia

BACKGROUND

Oropharyngeal dysphagia (OD), a common symptom in the elderly, uses commercial thickener (CT) as part of its treatment. This is often accompanied of dislike and poor compliance.

AIM

Describe adherence to CT and possible differences according to dwelling location in an area of influence of approximately 400.0000 inhabitants.

METHODS

Cohort prospective observational study. Randomized patients from Nutrition and Dietetic (NDU)-database (4 calls-interviews/year).

VARIABLES

Age, diagnostic, gender, dwelling/location: Home (H) / Nursing Home (NH), viscosity (nectar, honey, pudding), days with CT. Adherence measured with a questionnaire, considering implementation of treatment by combining CT use and consumption data, categorised in three groups good, moderate and poor. Change in patterns (improvement, maintenance, worsening) and non-adherence reasons.

RESULTS

One hundred sixty-eight patients recruited with indicated viscosity: Nectar 39.7%, honey 29.3% and pudding 30.8%. Average age of 82.6 ± 11.1 years; 57.8% women (46.4% at H vs. 67% at NH, p < 0.01). Dwelling/location: 80 (47.6%) live at H and 88 (52.4%) at NH. Days with CT prior study were 509 ± 475.28. Implementation found in first call: good in 50%, moderate in 20.2% and poor in 29.8%. At first call, adherence parameters were more favourable in NH compared to H. However these parameters were reversed during the study period as there was an improvement at H vs. NH. Also in terms of change in patterns a significant improvement of implementation was found in patients living at H, 31.1% vs. those living at NH, 15.7%, p < 0.05. CT persistence throughout study was 89.7%.

CONCLUSIONS

Low adherence to CT found in our community. Telephone follow-up resulted in improved adherence, especially in the H population. Our data provides valuable insights into the variability and changes in CT adherence among patients with OD. Adherence is complex and subject to many factors and dwelling/location is one of them. This study reveals the need to approach CT treatment for OD differently in NH.

Dysphagia in hospitalized patients: Prevalence, related factors and impact on aspiration pneumonia and mortality

BACKGROUND

Oropharyngeal dysphagia can be highly concerning in hospitalized patients, increasing morbidity and mortality, making its early identification essential. We aimed to characterize dysphagia and its association with aspiration pneumonia and mortality in a tertiary hospital in Barcelona, Spain.

METHODS

Using data from all hospital discharges during the period 2018-2021, we identified the characteristics of patients with dysphagia and their distribution among hospital departments through the minimum data set, which codifies patients' diagnoses according to the International Classification of Diseases 10th Revision (ICD-10). We used logistic regression models to assess the association between dysphagia, aspiration pneumonia and mortality.

RESULTS

Dysphagia was present in 2.4% of all hospital discharges and was more frequent in older patients and in men. The diagnoses most frequently associated with dysphagia were aspiration pneumonia (48.2%) and stroke (14%). Higher prevalence of dysphagia was found in the acute geriatric unit (10.3%), neurology (7.6%) and internal medicine (7.5%) wards. Dysphagia was associated with aspiration pneumonia, aOR = 8.04 (95%CI, 6.31-10.25), and independently increased the odds of death among hospitalized patients, aOR = 1.43 (95%CI, 1.19-1.73).

CONCLUSIONS

We conclude that dysphagia is a prevalent and transversal condition, increasing the risk of mortality in all patients, and efforts should be intensified to increase its early detection and correct management.

Combining Liquid Oral Drugs with Thickener: Compatibility and Changes in Viscosity

Older adults with oropharyngeal dysphagia (OD) are unable to swallow pills safely, so some of them use liquid-formulated drugs mixed with thickeners to ensure safety. The aim of this study was to analyze the physical compatibility of a group of drugs with a thickener formulated with modified starch (Thick & Easy®). A secondary goal was to evaluate the amount of thickener needed to obtain the thickness levels 2, 3, and 4 defined by IDDSI framework for each drug. For this purpose, the rheological properties of the mixtures obtained were determined. Samples of each drug were prepared and 7, 10, and 12 g of thickener were added. Physical compatibility of the mixtures was observed; the apparent viscosity of the samples was measured using a rotational viscometer, and the results obtained were compared with the reference drug-free sample. We analyzed 45 medicinal products (38 active substances). Three drugs (almagate, ibuprofen, and macrogol) were found to be physically incompatible with the thickener and should not be mixed. Viscosity measurements indicated that clarithromycin and plantago ovata increased the viscosity of the mixture and required lower amount to achieve the target textures (110 cP, 590 cP, and 2620 cP for 7 g, 10 g, and 12 g in drug-free samples, respectively), whereas another subset reduced viscosity and required more thickener. This proved very relevant for acetylcysteine, amoxicillin, calcifediol, ferrous gluconate, fosfomycin, lactitol, lactulose, mepifiline, paracetamol, rivastigmine, sertraline, and tramadol. Measurements were below 1750 cP. Awareness of how each drug behaves when combined with thickeners is essential to avoid potential complications in OD.

Knowledge and Practice of Health Professionals in the Management of Dysphagia

The aim of this study was to determine healthcare providers' knowledge and practices about dysphagia. A descriptive cross-sectional study was carried out based on a self-administered and anonymous questionnaire addressed to healthcare providers in Spain. A total of 396 healthcare providers participated in the study. Of these, 62.3% knew the definition of dysphagia as a swallowing disorder. In addition, up to 39.2% of the participants reported that they did not know whether the EatingAssessmentTool (EAT-10) dysphagia screening test was usedin their own clinical settings. Similarly, up to 49.1% of them did not know the ClinicalExaminationVolume-Viscosity (MECV-V) method. Nearly all participants (98.8%) reported that thickeners must be used forall liquids administered to patients. A higher percentage of respondents based the choice of texture on patient's tolerance (78.2%) rather than on the MECV-V result (17.3%). In addition,76.4% of the professionals had witnessed a bronchoaspiration; after it, 44.4% (n = 175) of them reported the appearance of pneumonia, and 14.5% (n = 57) the death of the patient (p = 0.005). The participants revealeda moderate/low knowledge ofthe definition, diagnosis, and clinical management of liquid dysphagia, which indicates some room for improvements.

Prevalence of dysphagia in a regional hospital setting: Acute care hospital and a geriatric sociosanitary care hospital: A cross-sectional study

RATIONALE

Oropharyngeal Dysphagia (OD) is a symptom commonly found in hospitalized patients and related to a vast array of clinical diagnosis and to high morbidity and mortality that is becoming very important to identify. Our aim was to assess the prevalence of OD in our hospital setting.

METHODS

Cross-sectional randomized study to determine the prevalence of dysphagia in an acute care hospital (ACH) and long term care hospital (LTCH). Multiquestionnaire test performed to assess dysphagia with the bedside validated volume-viscosity swallow test (V-VST test), in those with the validated swallowing ability test, eating assessment tool (EAT-10)>3. Variables; sex, age (>65 y), diagnosis, mininutritional assessment (MNA), previous diagnosis of dysphagia (including any recommendations given before), EAT-10, V-VST, presence of dysphagia, type of diet prescribed (basal or therapeutic), use of thickener and diet texture (pureed with liquids allowed, pureed without liquids, soft diet, normal).

RESULTS

N = 200 patients (100 in each centre). 49% male; Age = 81.1 [65-101] years; Diagnostics: medical 70%/surgery 30%. Dysphagia analysis: 42% patients showed an EAT-10 > 3 so the V-VST test was done in these patients resulting in global prevalence of 28.5% (95% CI: 22.7-35.1). Among centres no significant differences were observed: ACH 30% (95% CI: 14-34) and LTCH 27% (95% CI: 19-36). Highlighting a greater concentration of dysphagia in Orthogeriatric and Neurological patients in the LTCH than in ACH (Pneumology, Internal Medicine and Cardiology). MNA analysis: 27% normal 44% risk 29% malnutrition. Malnutrition present in 50.9% of patients diagnosed with dysphagia, 44% in those at risc (EAT-10 +) and 27.6% in those without risc or dysphagia (p = 0.020). From the novo patients, 75.4% did not have adequate complete adapted treatment (diet and thickener). Only 13.3% had their thickener prescribed. In those with history of dysphagia 37% had an inappropriate treatment.

CONCLUSION

Prevalence of OD matches with what is described in the literature. There is a high proportion of infradiagnostic and overall inadequate treatment, more than a third of patients do not have their diet adapted correctly. It is important to identify this symptom to treat it properly and to raise awareness among sanitary professionals for best adaptation of treatment.

[Importance of the detection of dysphagia in geriatric patients]

INTRODUCTION

Oropharyngeal dysphagia is one of the lesser known geriatric syndromes, despite its enormous impact on functional capacity, quality of life, and health of those affected.

MATERIAL AND METHODS

A descriptive and prospective study was conducted by the Geriatric Department of Barbastro Hospital (Huesca), from March 2012 to October 2014, as biannual and annual reviews in October 2015. This study included all patients on whom a volume-viscosity clinical examination (MECV-V test) was performed to suspecting dysphagia.

RESULTS

The study included 266 patients with a mean age of 82.35±12.3 years, and with a mean Barthel index score of 20.5±25.4, and mean Charlson index of 1.77±1.6. The test was performed in 105 cases after stroke (40%), 53 in dementia (20%), 24 in Parkinsonism (9%), and for other different reasons in 80 (31%). Dysphagia was diagnosed in 228 (86%) cases. Enteral nutrition was given in 25 (10.9%) cases. The test results were shown in the discharge report in 45% of the tests with positive result. The mean survival obtained after test in the patients who died was 230.8±256.5 days. Differences in survival at 12 months were found in patients with positive test, without finding a clear relationship with functional status and comorbidity.

CONCLUSIONS

Dysphagia has a significant mortality, and the use of thickeners after its detection should be properly reported.